Early versus late surgical decompression for traumatic thoracic/thoracolumbar (T1-L1) spinal cord injured patients: Primary results of a randomized controlled trial at one year follow-up

OBJECTIVE: To assess the efficacy of surgical decompression <24 (early) versus 24-72 hours (late) in thoracic/thoracolumbar traumatic spinal cord injury (TSCI). METHODS: A randomized controlled trial (RCT) of 35 T1-L1 TSCI patients including early (n=16) and late (n=19) surgical decompression was conducted in the neurosurgery department of Shahid Rajaee Hospital from September 2010. Pre- and postoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor/sensory scores, length of hospitalization, complications, postoperative vertebral height restoration/rebuilding and angle reduction, and 12-month loss of height restoration/rebuilding and angle reduction were evaluated. RESULTS: Sixteen patients (46%) had complete TSCI. No AIS change was seen in 17 (52%) patients. Complete TSCI patients had no motor improvement. The AIS change in this group was solely due to increased sensory scores. For incomplete TSCI, the mean motor score improved from 77 (±22) to 92 (±12) in early, and from 68 (±22) to 82 (±16) in late surgery. One deep vein thrombosis was observed in each group. There were 2 wound infections, one CSF leak, one case of meningitis, and one decubitus ulcer in the late surgery group. Six screw revisions were required. CONCLUSION: Our primary results show overall AIS and motor score improvement in both groups. Motor improvement was only observed in incomplete TSCI. Two-grade improvements in AIS were seen in 3 early, and one late surgery patient.